A decade ago, when Sofya Tokarev, 62, received treatment for an advanced form of cancer, she never imagined the cure would come at a cost so high. By the time she found her way to NYU Langone Levit Medical in Brooklyn, in 2016, she had developed advanced heart failure, a potential complication of some aggressive chemotherapies. Last December, she was so weak she could barely manage a couple of steps. “I had broached the topic of a heart transplant before,” says heart failure specialist Alex Reyentovich, MD, “but now Sofya let go of her reluctance.”
Dr. Reyentovich is the medical director of NYU Langone’s new Heart Transplant Program, which closely collaborates with six NYU Langone ambulatory practices, including NYU Langone Levit Medical, to assess and manage heart failure patients within their communities. As long as immunosuppressants succeed in preventing organ rejection, Dr. Reyentovich had explained to Tokarev, a transplant could extend life for 13 years or longer, and provide a high quality of life, too, with no physical limitations.
On Friday January 5, 2018, Tokarev was matched with a potential donor in Massachusetts, and transplant surgeon Kazuhiro Hisamoto, MD, was sent to procure the organ. By 9:00PM that evening, Nader Moazami, MD, NYU Langone’s new surgical director of heart transplantation and mechanical circulatory support—assisted by fellow transplant surgeon Deane E. Smith, MD—had given Sofya Tokarev a new heart, and a new lease on life.
The operation, the first of three heart transplants NYU Langone performed in January, came less than one month after New York State’s Department of Health granted approval for heart transplantation, and the 50th anniversary of the first human heart transplant. (In January, NYU Langone also received approval to perform lung transplants, appointing Zachary N. Kon, MD, formerly director of heart and lung transplantation at the University of Maryland Medical Center, as surgical director of its new Lung Transplant Program.) “Transferring a patient to another institution for a transplant disrupts the continuity of care,” says Aubrey C. Galloway, MD, the Seymour Cohn Professor of Cardiothoracic Surgery and chair of the Department of Cardiothoracic Surgery. “We no longer need to do that.”
NYU Langone’s heart transplant program—a collaboration between its Transplant Institute, Department of Cardiothoracic Surgery, and Leon H. Charney Division of Cardiology—is the first such program approved in New York City in more than 15 years. To spearhead it, NYU Langone recruited Dr. Moazami from the Cleveland Clinic, where he led its heart transplant program, earning international recognition as a clinician and researcher. “What makes this program special is that it’s very comprehensive and multidisciplinary, yet very patient centered,” explains Dr. Moazami, who has performed more than 300 heart transplants. “This is a life-changing proposition for patients, and the environment we’ve created for them is a very caring one.”
The demand for heart transplants has never been higher. More people are surviving heart attacks, placing them at higher risk for heart failure. An estimated 6.5 million Americans live with heart failure. Such patients at NYU Langone who are candidates for a heart transplant or a ventricular assist device (an implanted mechanical circulatory support pump) are evaluated by a team of cardiologists and other specialists led by Dr. Reyentovich. “As an institution with a premier transplant institute and several hospitals in the New York area, we can now provide the full spectrum of state-of-the-art care for a large population of patients with advanced heart disease,” says Robert Montgomery, MD, director of the Transplant Institute.
The demand for heart transplants has never been higher. An estimated 6.5 million Americans live with heart failure. By 2030, that number is projected to rise by some 50 percent.
For NYU Langone, a successful transplantation program must not only deliver the highest quality of care, but also squarely address the critical shortage of donor organs, a crisis that is particularly acute in New York State. Only 28 percent of the state’s residents are registered organ donors—the lowest rate in the country. While 161 heart transplants were performed in 2016 at the five existing transplant centers throughout the state, some 1,000 people died waiting for a donor heart to become available.
To earn state approval, NYU Langone developed a comprehensive strategy for increasing donation and transplantation rates. Among its priorities is research to rehabilitate the hundreds of potential donor hearts rejected annually in the U.S. due to diseases such as hepatitis C.
“You can always find a reason to reject a marginal heart,” says Dr. Moazami. “But the key is to accept as many hearts as possible because this is a truly lifesaving procedure. You win the confidence of patients by demonstrating that you’re the best. We have everything in place to ensure that we are.”